What Are the Medicare Coverage Gap Limits?


Quick Answer

The coverage gap is a temporary limit on what most Medicare plans cover for prescription drugs, according to Medicare.gov. It is also known as the donut hole, and not everyone reaches it.

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Full Answer

The coverage gap in 2015 begins once a member receives $2,960 of coverage. In 2016, the limit increases to $3,310, and it may change every year, states Medicare.gov. People who are under the Extra Help Medicare plan do not enter the coverage gap. Once a member reaches the coverage cap, he pays 45 percent of the cost of drugs. A Medicare patient can get discounts if he gets drugs from a pharmacy or orders drugs via mail.

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